Antibiotic prescriptions and cycles of Mycoplasma pneumoniae infections in Norway: can a nationwide prescription register be used for surveillance?

SUMMARYMycoplasma pneumoniae outbreaks cause increased use of macrolides and tetracyclines. We aimed to investigate whether drug use data, in addition to laboratory data, could improve understanding of the spread of M. pneumoniae epidemics. Number of users of Mycoplasma antibiotics (erythromycin, doxycycline, clarithromycin) per week and county of residence in an indicator age group (6–12 years) was retrieved from the Norwegian prescription database for the epidemic season 2011–2012 and compared to non-epidemic seasons. In 2011, increased use of Mycoplasma antibiotics was first observed in September on the west coast of Norway. The Norwegian laboratory-based surveillance system showed the first increase in positive tests in August 2011 and an epidemic was announced on 25 October 2011. At that time the use of Mycoplasma antibiotics had already exceeded three times the use in non-epidemic periods. Data for three counties from the regional microbiological laboratories showed that the increase in number of positive samples coincided in time with the increase in prescription data. Laboratory data cannot accurately determine the extent of an epidemic, and drug use data cannot identify the cause. Establishing a systematic interaction between the two monitoring systems will enhance surveillance and probably contribute to improved infection control and prudent antibiotic prescribing.

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Self-reported data on medicine use in the Norwegian Mother and Child cohort study compared to data from the Norwegian Prescription Database

Norsk Epidemiologi ◽

10.5324/nje.v24i1-2.1824 ◽

2014 ◽

Vol 24 (1-2) ◽

Cited By ~ 7

Author(s):

Svetlana Skurtveit ◽

Randi Selmer ◽

Ingvild Odsbu ◽

Marte Handal

Keyword(s):

Cohort Study ◽

Drug Use ◽

Pregnant Women ◽

Time Windows ◽

Prescription Database ◽

Prescription Data ◽

Reference Standard ◽

Mother And Child ◽

Norwegian Prescription Database ◽

Reported Data

Aims: To study information on prescribed drug use (opioids, antidepressants and benzodiazepines (BZD)) recorded in the Norwegian Prescription Database (NorPD) and to compare this information with selfreported drug use among pregnant women in the Norwegian Mother and Child Cohort Study (MoBa).Materials and methods: The study population consisted of 28 479 women who participated in MoBa and who answered all questionnaires in pregnancy and whose pregnancy started after 1 March 2004. Data on dispensed drugs in NorPD were extracted for three different time windows: a) the pregnancy period, b) 30 days prior to pregnancy in addition to pregnancy, c) 60 days prior to pregnancy in addition to pregnancy. Data on self- reported drug use in MoBa were used as the reference standard in the validity analysis. Sensitivity and specificity were calculated.Results: Sensitivity of drug use as recorded in NorPD for the pregnancy period was highest for antidepressants (66.9%) and BZD-antiepileptics (100%) and lowest for BZD-anxiolytics (44.8%) and BZDhypnotics (27.8%). Expansion of the time windows for dispensed drugs in the NorPD to include intervals 30 and 60 days before pregnancy led to higher sensitivity, but lower specificity of all classes of drugs. For opioids, sensitivity increased from 48.8% to 53.6%, while specificity decreased from 98.7 to 97.6%. For antidepressants and BZD-anxiolytics, specificity decreased for both from 99.7 to 99.4%.Conclusion: Using self-reported data as reference standard, the prescription data provides valid information on current exposures to BZD-antiepileptics and antidepressants in pregnant women if time windows are selected with adequate consideration depending on the investigated problem. However, validity is lower for other benzodiazepines and opioids.

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Can subjective well-being and body concern in adolescence predict prescribed medication in adulthood? Findings from the Nord-Trøndelag Health Study and the Norwegian Prescription Database

Scandinavian Journal of Public Health ◽

10.1177/1403494819863516 ◽

2019 ◽

Vol 48 (5) ◽

pp. 559-566

Author(s):

Adelheid-Charlotte Wærholm ◽

Eivind Meland ◽

Reidun L. S. Kjome

Keyword(s):

Drug Use ◽

Well Being ◽

Health Study ◽

Health Determinants ◽

Prescription Database ◽

Adult Health ◽

Subjective Well Being ◽

Important Health ◽

Norwegian Prescription Database ◽

The Impact

Aim: To examine whether subjective well-being (SW) and body concern among adolescents aged 15–19 years has an impact on adult health, measured by medications dispensed on average 18 years later. Methods: Data collected in the Nord-Trøndelag Health Study (HUNT) was paired with data from the Norwegian Prescription database (NorPD). We investigated the effects of adolescent SW and body concern on total number of medications, on use of anti-infectives (ATC-group J), medication for the musculo-skeletal system (ATC-group M), anxiolytics, hypnotics and sedatives (ATC-groups N05B and N05C), and finally antipsychotics, antidepressants and psychostimulants, agents used for attention-deficit/hyperactivity disorder and nootropics (ATC-groups N05A, N06A and N06B). We used multi-variable models where we entered body dissatisfaction and SW simultaneously in the models in order to adjust for the associations between the predictors, and also adjusted for possible confounders in the models. Results: Both body concern (dieting and dieting desire) and impaired SW predicted drug use 17–18 years after the participants were surveyed in adolescence. The impact was disease specific as body concern was the most influential predictor for drugs used for somatic diseases and complaints, whereas impaired SW was more strongly associated with drug use for mental health diseases and complaints. Conclusions: SW and body concern are important health determinants in the transition between adolescence and adulthood.

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1117. A Retrospective Analysis of Paediatric Prescribing in British Columbia from 2013 to 2016

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.981 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S397-S397

Author(s):

Ariana Saatchi ◽

David M Patrick ◽

James McCormack ◽

Andrew Morris ◽

Fawziah Marra

Keyword(s):

British Columbia ◽

Anatomical Therapeutic Chemical ◽

Age Groups ◽

Geographic Location ◽

Pediatric Care ◽

Antibiotic Prescribing ◽

Prescription Database ◽

Prescription Data ◽

Upper Respiratory Tract ◽

Tract Infections

Abstract Background Antibiotic prescribing in pediatric care is highly prevalent. Often children are prescribed antibiotics for conditions that are commonly self-limiting and viral in etiology such as upper respiratory tract infections. The purpose of this study was to examine the scope of pediatric antibiotic prescribing in British Columbia from 2013 to 2016 and identify potential new provincial antimicrobial stewardship targets. Methods Antibiotic prescription data for children were extracted from a provincial prescription database, and linked to demographic files in order to obtain patient age, sex and geographic location. Prescription rates were then calculated, and trends were examined by major anatomical therapeutic chemical (ATC) classification. Results Our cohort included an average of 271,134 children per year and 1,767,652 antibiotic prescriptions. Over the 4 years, rates of antibiotic prescribing increased 4.5% (from 453 to 474 prescriptions per 1,000 population per year). The greatest increase, across all classes of antibiotics, was seen in children aged 0–2 years of age. By 2016, the greatest increase in prescribing, by class, was observed in J01X (e.g., nitrofurantoin, fosfomycin) with a 1360% increase for children aged 3–9. Across all ages, quinolones (J01M) increased 98%. Remaining classes, including β lactams (J01C), and macrolides (J01F), experienced modest reductions in the older age groups. Conclusion Past studies have illustrated decreasing or static rates of antibiotic prescribing in British Columbia. However, we have identified a paradoxical (4.5%) increase in pediatric antibiotic prescribing since 2013. Although it appears that provincial efforts have been successful in reducing the use of broad-spectrum penicillins (J01C), marked surges in the use of classes like tetracylines (J01A), quinolones (J01M), and other antibacterials (J01X) identify a new potential target for provincial stewardship. Disclosures All authors: No reported disclosures.

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Psychotropic drug use in the Norwegian general population in 2005: data from the Norwegian Prescription Database

Pharmacoepidemiology and Drug Safety ◽

10.1002/pds.1756 ◽

2009 ◽

Vol 18 (7) ◽

pp. 572-578 ◽

Cited By ~ 31

Author(s):

Svein R Kjosavik ◽

Sabine Ruths ◽

Steinar Hunskaar

Keyword(s):

Drug Use ◽

General Population ◽

Psychotropic Drug ◽

Prescription Database ◽

Psychotropic Drug Use ◽

Norwegian Prescription Database

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Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study

Journal of Opioid Management ◽

10.5055/jom.2016.0309 ◽

2016 ◽

Vol 12 (1) ◽

pp. 25 ◽

Cited By ~ 2

Author(s):

Siri Brelin, MD ◽

Olav M. Fredheim, MD, PhD ◽

Jon H. Loge, MD, PhD ◽

Svetlana Skurtveit, PhD ◽

Tom B. Johannesen, MD, PhD ◽

...

Keyword(s):

Odds Ratio ◽

Prescription Database ◽

Prescription Data ◽

Pharmacoepidemiological Study ◽

Patients With Cancer ◽

Sociodemographic Data ◽

Norwegian Prescription Database ◽

Study Population ◽

To Receive ◽

Cancer Diseases

Objective: Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors.Design: Retrospective, registry-based, national study.Patients: This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway.Results: The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively).Conclusion: The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.

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218. Changes in Dental Antibiotic Prescribing in the United States, 2012–2017

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.262 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S111-S111

Author(s):

Swetha Ramanathan ◽

Connie H Yan ◽

Colin Hubbard ◽

Gregory Calip ◽

Lisa K Sharp ◽

...

Keyword(s):

The United States ◽

Cross Sectional Study ◽

Antibiotic Prescribing ◽

Prescription Data ◽

Oral Antibiotic ◽

Sectional Study ◽

Cross Sectional ◽

Prescribing Trends ◽

Adults And Children ◽

Linear Regressions

Abstract Background Data suggest dental antibiotic prescribing is increasing with relatively less documented about prescribing trends in adults and children. Therefore, the aim was to evaluate trends in antibiotic prescribing by US dentists from 2012–2017. Methods This was a cross-sectional study of US dental prescribing using IQVIA Longitudinal Prescription Data from 2012 to 2017. Prescribing rates (prescriptions [Rx] per 100,000 dentists), mean days’ supply, and mean quantity dispensed were calculated monthly across eight oral antibiotic groups: amoxicillin, clindamycin, cephalexin, azithromycin, penicillin, doxycycline, fluoroquinolone, and other antibiotics. Descriptive frequencies and multiple linear regressions were performed to obtain trends overall and stratified by adults (≥ 18) and children (< 18). Results 220, 325 dentists prescribed 135 million Rx (94.0% in adults). 61.0% were amoxicillin, 14.4% clindamycin, 11.7% penicillin, 4.4% azithromycin, 4.3% cephalexin, 2.0% other antibiotics, 1.4% doxycycline, and 0.7% fluoroquinolones. Prescribing increased by 33 Rx/100,000 dentists (p< 0.0001) each month for all antibiotics. Amoxicillin (p< 0.0001) and clindamycin (p=0.02) prescribing rate increased by 73 and 5 Rx/100,000 dentists, respectively. Prescribing decreased by 8, 12, and 2 Rx/100,000 dentists for cephalexin (p< 0.0001), doxycycline (p< 0.0001), and fluoroquinolones (p=0.008), respectively. Mean days’ supply increased for amoxicillin, penicillin, and clindamycin (p< 0.0001), and decreased for cephalexin (p< 0.0001).Mean quantity dispensed decreased (p< 0.0001) for all groups except azithromycin and doxycycline. Among adults, cephalexin prescribing rates (7 Rx/100,000 dentist; p< 0.0001) and other antibiotics days’ supply (p< 0.0001) decreased. Among children, azithromycin prescribing rates (1 Rx/100,000 dentists, p=0.02), and fluoroquinolone and other antibiotics days’ supply (p< 0.0001) decreased. Conclusion These findings support dental antibiotic prescribing is increasing, specifically for amoxicillin and clindamycin. Further, trends differed between adults and children. Understanding what is driving these trends is important to target dental antibiotic stewardship efforts. Disclosures All Authors: No reported disclosures

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A Retrospective Descriptive Study on Death Due to Cyanide Poisoning Over a Period of 20 Years in Government Medical College, Thiruvananthapuram

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/496 ◽

2021 ◽

Vol 8 (30) ◽

pp. 2697-2701

Author(s):

Sasikala K ◽

Vitni Fernz ◽

Abitha Raj B.T ◽

Ajith V. Asok ◽

Amritha Mathew ◽

...

Keyword(s):

Social Sciences ◽

Preliminary Investigation ◽

Laboratory Data ◽

Descriptive Study ◽

Serial Killers ◽

Age Group ◽

Cyanide Poisoning ◽

Microsoft Excel ◽

Medical College ◽

Pro Forma

BACKGROUND Cyanide is a rapidly acting poison which has been the suicidal agent of choice since time unknown. Its notoriety also extends to homicide, and it has often been used by serial killers. It is found in nature and is used in various industries, but is difficult to obtain nowadays as a result of strict policy implementation. METHODS All cases of cyanide poisoning over a period of 20 years from 2000 to 2019 were studied. Samples were sent for identification and quantification by GC-MS to the chemical examiner’s laboratory. Data was collected in pro forma and entered into Microsoft Excel and analysed using statistical package for social sciences (SPSS). RESULTS A total of 84 cases were studied over a period of 20 years. The majority of cases were recorded in the first decade of the study period. Most common age group involved was 31 to 40 years. Males comprised 84.9 % of the total. Majority were suicidal in nature, and 22.6 % were suicide pacts. The reason for committing suicide could not be found in 59.3 %. 67.9 % were found dead or brought dead to the hospital. In 24 % cases, the typical smell of bitter almonds was identified. Police were able to make out the presence of poison in 83.3 % during the preliminary investigation. CONCLUSIONS Males were the commonly affected. Ingestion of poison was the method of administration in all cases. Majority were suicides, and occurred in the residence of the victims. In majority of cases, police could identify the cause of death as poisoning. The characteristic smell could be identified only in a few cases. KEYWORDS Cyanide, Corrosion, Poisoning, Suicide

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Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

10.21203/rs.2.23539/v1 ◽

2020 ◽

Author(s):

Huan Deng ◽

Yifan Zhu ◽

Jiamin Zhang ◽

Qiangquan Rong ◽

Yao Quan ◽

...

Keyword(s):

Mycoplasma Pneumoniae ◽

Lymphocyte Count ◽

Clinical Characteristics ◽

Clinical Symptoms ◽

Laboratory Data ◽

Point Mutations ◽

Community Acquired Pneumonia ◽

Pulmonary Complications ◽

23S Rrna ◽

Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study’s purpose is to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil count, and lymphocyte count, immunomodulators treatment and pulmonary complications.Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was comparable.Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory pneumonia. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

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Prospective Population-Based Analysis of Characteristics and Therapy Options in AML: The Case of Catalonia (PERIS Project)

Blood ◽

10.1182/blood-2020-139160 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 32-33

Author(s):

Montserrat Hoyos ◽

Ana Garrido ◽

Montserrat Arnan ◽

Marina Diaz-Beyá ◽

Olga Salamero ◽

...

Keyword(s):

Clinical Trials ◽

Board Of Directors ◽

Hematopoietic Cell Transplantation ◽

Clinical Laboratory ◽

Laboratory Data ◽

Population Based ◽

Advanced Age ◽

Age Group ◽

Advisory Committees ◽

Low Intensity

Introduction:Acute myeloid leukemia (AML) real-world incidence has been investigated in a limited number of European countries such as Sweden, Denmark and a few others. These prospective population-based analyses give a more precise idea of AML as a health problem than registry data from cooperative groups or other sources, that usually include selected cases as part of research studies and/or therapy trials. In October 2016, the Autonomous Government of Catalonia funded a project (PERIS SLT002/16/00433) to prospectively collect all AML cases from our territory. Objective:To investigate the incidence, characteristics and treatment decisions in all consecutive AML patients diagnosed in Catalonia between January 2017 and December 2019. Methods:Inclusion criteria were diagnosis of AML according the WHO 2016 criteria, both primary and secondary (APL excluded) with an age >18 years. The project was disseminated to all hospitals from Catalonia regardless of their size, having at least one hematologist. A specific informatics tool was implemented for remote reporting of the cases. All data were anonymized. In parallel, a circuit for centralized bio banking of patients' samples was designed. The database included the main clinical, laboratory data as well as the initial therapeutic approach. Cases included in our CETLAM group cooperative studies were automatically linked to the trial database for collecting detailed information. Statistical analyses were performed with R packages. Results:Assuming an incidence of AML of 4 cases per 100,000 inhabitants (based on previous reported data from others), we expected 912 cases during three years in the 7,6 million population of Catalonia. Our prospective registry included 750 consecutive AML patients, 82% of the expected cases. The remaining 18% could be explained by the exclusion of APL, age below 18 years, or underreporting. Seventy percent of patients (n=527) were diagnosed and treated in the 5 large University Hospitals from Barcelona and the two adjacent cities (Badalona and Hospitalet). Table 1 shows the main characteristics of the patients. Among the 390 patients up to 70 years, 272 (70%) were enrolled in the CETLAM AML-12 protocol that included intensive chemotherapy (ICT) and risk adapted hematopoietic cell transplantation (HCT). Forty-one additional patients (11%) in this age group received other ICT in different clinical trials. A remaining 73 patients (20%) were treated with other intensive or non-intensive approaches outside trials. In the group of 360 patients older than 70 years only a 33% (n= 119) were treated under the risk-adapted CETLAM AML-16 protocol for elderly AML patients. This trial included ICT as in the CETLAM-12 in case of favorable genetic features; this was received by 13 of the 119 patients (11%) enrolled. The remaining patients of CETLAM-16 were treated with low-intensity chemotherapy (oral fludarabine, subcutaneous (SC) cytarabine and G-CSF or azacytidine) and 97 additional elderly patients were included in other clinical trials mostly with targeted and hypomethylating agents (27%). Other active therapies outside trials (usually low-intensity) were administered in 50 additional patients (14%) whereas the remaining 94 patients (26%) only received supportive measures (transfusions, hydroxyurea, antibiotics, palliation, or no treatment), because of one or more of the following: advanced age, poor AML features or severe clinical condition. Overall survival (OS) of the whole series at 2 years was 31±2% (CI: 27-35). Patients younger than 70 years had a 2-year OS of 47±3% (CI: 41-53) compared to 11±3% (CI: 7-17) for those above 70 years (p<0.001) (Image 1). Conclusions:This prospective study is highly representative of the diagnosis and treatment of AML in Catalonia. The median age at diagnosis was 70 years. Of note, 81% of patients up to 70 years were enrolled in ICT trials. The proportion of patients in trials in the elderly group was lower although still remarkable (60%). In this advanced age group, a 26% of patients were treated with supportive measures only. Despite the high inclusion rate in clinical trials, only one third of newly diagnosed AML patients have the probability to survive at 2 years, with a dismal outcome in those above 70 years. Therefore, the investigation of novel and more effective treatments remains mandatory. This series will be detailed and updated during the meeting. Disclosures Salamero: Pfizer:Consultancy;Jazz Pharmaceuticals:Consultancy, Honoraria;Daichii Sankyo:Honoraria;Novartis:Consultancy, Honoraria;Celgene:Consultancy, Honoraria.Olivera:BAYER:Consultancy;Pfizer:Consultancy, Speakers Bureau;Daiichi Sankyo:Consultancy, Speakers Bureau;Boehringer Ingelheim:Consultancy, Speakers Bureau.Sureda Balari:Celgene:Consultancy, Honoraria;Merck Sharpe and Dohme:Consultancy, Honoraria, Speakers Bureau;Sanofi:Consultancy, Honoraria;Novartis:Consultancy, Honoraria;Gilead/Kite:Consultancy, Honoraria;Janssen:Consultancy, Honoraria;Incyte:Consultancy;Roche:Honoraria;BMS:Speakers Bureau;Celgene/Bristol-Myers Squibb:Consultancy, Honoraria;Takeda:Consultancy, Honoraria, Speakers Bureau.Ribera:Pfizer, Amgen:Research Funding;Pfizer, Amgen, Ariad, Novartis:Consultancy, Speakers Bureau.Sierra:Jazz Pharmaceuticals:Research Funding;Pfizer:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Daiichi Sankyo:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Abbvie:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Astellas:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Roche:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees;Gilead-Kite:Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

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